Adhesions in the uterus causes the appearance. Methods for diagnosing adhesions

If adhesions form between the posterior and anterior walls of the uterus, then the uterine cavity is deformed, and sometimes completely absent.

Causes of adhesions in the uterus

Synechia is formed as a result of the fact that the body is trying to defend itself by isolating the lesion from healthy tissues and organs.

The main reasons for the formation of adhesions are:

inflammatory processes in reproductive organs women in which there is a violation of the integrity of the inner layer of the uterus. As a result, fibrin begins to be released, which contributes to the gluing of the walls of the organ. Fibrin threads germinate with collagen protein fibers and strong adhesions are formed.
Hormonal disorders.
Injuries. May occur with improper installation or displacement of the IUD, spontaneous miscarriage, abortion and childbirth.
Surgical interventions (destruction uterine septa with its abnormal development, curettage of the uterine cavity to remove fibroids or polyps, C-section and so on).
Frozen pregnancy. Cells that synthesize fibroblasts are activated, which can lead to the formation of intrauterine synechia.
tuberculosis of the endometrium.
Radiation therapy for pelvic tumors and abdominal cavity.

Symptoms of adhesions in the uterus

If there are few synechiae in the uterine cavity, then the disease may be asymptomatic. Clinical manifestations mainly refer not to the spikes themselves, but to the complications they cause.

The main symptoms are:

Pain in the lower abdomen that gets worse different periods cycle.
Hypomenorrhea (menstruation becomes short and scanty), dysmenorrhea (pain during menstruation that occurs if synechia prevents the outflow of blood from the uterus).
Amenorrhea (lack of menstruation). Occurs when complete obliteration of the uterus occurs.
Spontaneous miscarriages.
Infertility.

Diagnosis of adhesions in the uterus

With the help of modern diagnostic equipment you can see even the most minimal changes and identify the development of synechia at an early stage.

For the diagnosis of adhesions, the following methods are used:

Ultrasound of the pelvis. For the diagnosis of synechia, it is best to carry out this study in the second phase of the cycle.
Hysterosalpingography. X-ray method diagnosis using a contrast agent.
Hysteroscopy. Used as a diagnostic operation.
Paypel biopsy. Vacuum sampling of the endometrium is performed for subsequent examination and detection infectious causes diseases.
Lack of response to the use of hormonal drugs.
No changes in the hormonogram.

Treatment of adhesions in the uterus

Women are usually concerned about the question: "How to treat adhesions, is surgery necessary?" If synechia is detected in the uterus, treatment is only surgical. A surgical operation during which adhesions are destroyed under the control of a special miniature camera built into the hysteroscope is called hysteroresection. With its help, it is possible to remove existing adhesions without damaging the healthy endometrium.

IN postoperative period appointed:

antibacterial and replacement therapy- to prevent inflammation;
physiotherapy - to prevent recurrence of the disease, restore the endometrium and normalize the function of the reproductive organs.

If you have adhesions in your uterus or if you suspect this pathology, contact the AltraVita clinic. Here practice the most modern methods diagnosis and treatment of this disease. We will help remove adhesions while maintaining health and reproductive function women.

Women often turn to gynecologists with complaints of pain in the pelvic area, changes in the cycle of menstruation, the inability to become pregnant, or early miscarriages. Such symptoms can cause adhesions in the uterus.

Adhesions are connective tissue formations that occur at the site of injury or inflammation. They violate normal functioning organs, and if located in the uterus, they lead to infertility. The causes can be varied, and treatment should be carried out immediately.

The principle of education and variety

Any damage to the mucous membranes or tissues of the body causes defensive reaction which aims to restore the structure and functions of organs.

Substances that form connective tissue enter the affected area from the plasma. A film of it covers the wound surface and promotes its recovery. As healing progresses, the connective tissue is destroyed by fibrinolytic substances. With deep lesions, a scar remains. Low level fibrinolytics in the blood causes adhesions.

Spikes are found in different bodies and body cavities. They can be thin, elastic, or unite into large strands, sprouted by blood vessels and nerves. Adhesions in the uterus can move from the uterus to the fallopian tubes, bladder, ovaries, intestines or abdominal wall.

Important! Adhesions can be caused by endometriosis. This disease is associated with an atypical proliferation of the endometrium, which extends into the ovarian region, or into the abdominal cavity. Its ability to be cyclically renewed causes bleeding, and they contribute to the development of adhesions.

Inside the uterus, adhesions can connect the anterior and posterior surfaces, form cavities and pockets, and also pass to the tubes and cervix. The adhesive process in the uterine cavity is isolated as Asherman's syndrome. Adhesions are usually called synechia, they are formed with deep damage to the endometrium. The endometrium covers internal cavity uterus and consists of two layers: functional and basal. During menstruation functional layer breaks down and is excreted in the blood.

The formation of synechia is associated with damage to the basal layer, its cells lack the ability to divide. Therefore, they cannot be restored if damaged. Therefore, it is important to identify the causes and symptoms of their formation in time and begin treatment. Synechia can consist of the endometrium (thin films), be fibromuscular (easily dissected, bleed) or connective tissue (dissected with difficulty, do not bleed).

Causes of the adhesive process

Formed when the peritoneum is damaged. It could be trauma inflammatory diseases abdominal organs, surgical interventions. More often formed in people who have a genetic predisposition to adhesion formation.

The reasons for the formation of synechia in the uterus are different:

Injury to the inner layer of the uterus. Occur during surgical and diagnostic interventions (curettage, removal of fibroids), miscarriages, childbirth, injuries associated with the installation of an intrauterine device;
Frozen pregnancy. The fetus dies and is destroyed, this increases the activity of fibroblasts, which are involved in the formation of connective tissue;
Infectious and inflammatory diseases of the uterus. They are called coli, chlamydia, trichomonads, gonococci, or opportunistic pathogens. common cause formation of synechia is genital tuberculosis.

The adhesive process can be found in the cervical canal if its epithelium is damaged.

Symptoms of the disease

If a woman has synechia, then this makes it difficult for sperm to move to the mouth of the tubes, prevents attachment gestational sac, violates the free separation of blood and endometrium during menstruation. The reason for going to the doctor is a violation of the cycle of menstruation and infertility.

Women complain of pain in the pelvic area, they may occur during sex, menstruation (intensify just before it starts). The cyclicity of menstruation is not broken, but they are long and there is little discharge. WITH further development diseases and an increase in the number of synechia appears amenorrhea (absence of menstruation). This condition is dangerous, as blood and endometrium accumulate in the uterine cavity. This causes inflammation.

When questioned, the patient can indicate the transferred urinary infections, abortions, surgeries, miscarriages, miscarriages, or infertility.

Important! Adhesions in the uterus can also form in women who have given birth, during difficult childbirth, caesarean section.

May reveal an increase in the size of the uterus, a change in its shape, pain when pressed. These symptoms are characteristic of endometritis. If the uterus is inactive, then the adhesive process may be in the small pelvis.

Diagnostics

To confirm the formation of synechia, an additional examination is carried out:

Ultrasonography. Allows you to detect fibromuscular and connective tissue adhesions, they are lighter in the resulting picture. The examination is carried out both through the wall of the abdomen (transabdominally), and through the wall of the rectum (transrectal) or vagina (intravaginally);
. The uterus is viewed from the inside. Whitish strands on the background normal endometrium- symptoms of adhesions;
Hysterosalpingography. X-ray of the uterus with an inserted into its cavity contrast agent. Allows you to detect defects in the filling of the uterus with contrast in synechia, and shows;
Nuclear magnetic tomography. Usually carried out with the introduction of a contrast agent;
Paypel biopsy. Using a vacuum, the biological material of the uterus is taken. Then histological examination is carried out.

Radiography of the uterus with a contrast agent injected into its cavity.

Possible Complications

Depending on the degree of damage, there are three degrees of the disease. With the first degree of synechia, they are single or few, they do not go to the bottom and fallopian tubes. In the second, they can cover the bottom and mouths of the pipes, but the amount of the affected endometrium does not exceed 70%. In the third degree, synechia fills the entire uterine cavity, endometrial damage is more than 70%.

Infertility can be observed at any degree of the disease. Complications usually occur in the second and third degrees. This is due to a violation of the outflow of secretions during menstruation. Blood is retained in the uterus, this leads to a hematometer. If an infection joins and pus forms, then a diagnosis is made - pyometra.

Important! Hematometra and pyometra are characterized severe pain in the abdomen, temperature. They are dangerous for the patient and require surgical intervention.

Treatment Methods

Adhesions in the uterus treat only surgically. Treatment conservative methods allow to soften, increase the elasticity of the formation, but does not completely destroy it. It is applied when pain syndrome caused by adhesions in the abdominal cavity and single synechiae. Showing physiotherapy (ozocerite applications), the introduction of fibrinolytics (lidase).

is a diagnostic and surgical operations, in which huge incisions are not made in the abdominal cavity, and access to the internal organs occurs through the introduction of a video camera and instruments through the vagina and cervix.

In other cases, excision of synechia is indicated during hysteroscopy, using a hysteroscope. Subsequently found hormonal preparations and prescribed contraceptives. They allow you to exclude pregnancy for the period of therapy and restore the menstrual cycle.

Treatment should be carried out as early as possible. Synechia affects the basal layer of the endometrium, and it is almost impossible to restore it.

The adhesive process in the uterine cavity is dangerous by the possibility of developing complications and endometrial dysfunction. This leads to infertility, the treatment of which does not always good result. To prevent this from happening, young women should plan pregnancy, regularly visit a gynecologist, and identify and treat urinary infections in time.

Spikes in the cervix or fallopian tubes are called very thin filaments of connective tissues, and the reason for their formation is inflammatory processes or surgery. If the threads of connective tissues located in the cavity of the small pelvis and abdominal region, extend from one female organ to another, it can lead to infertility.

Adhesions may form in the uterus different reasons, moreover, it is impossible to determine the onset of the disease without the help of a physician. And if this problem is not detected immediately, then the transition of such a disease to chronic form, in this case healing processes they can drag on a lot, and they will be hard enough to pass. Only a timely visit to the appropriate female doctor- a gynecologist. It is not worth starting the disease, since the adhesions that appear have negative impact- they begin to gradually shift the entire female system which includes the ovaries, fallopian tubes and the uterus itself. As a result of this shift, the interaction between the fallopian tubes and the ovaries decreases and the desired fertilization of the egg and sperm does not occur.

The main causes of adhesions in the fallopian tubes and cervix

There are several reasons that affect the appearance of adhesions:

✔ gynecological operations;

✔ inflammatory processes in the appendages, fallopian tubes and uterus;

✔ endometriosis;

Treatment of adhesions in the uterus

When adhesions are detected in the uterus, doctors unambiguously prescribe to their patients surgery with the help of laparoscopy, as well as the treatment of uterine polyps in Israel, read about this on specialized sites. This method of treatment allows the separation of adhesions, then their removal.

In the course of treatment, the doctor prescribes and medications- anticoagulants and fibrinolytic agents.

In addition, all patients after the operation in without fail antibiotics are prescribed.

Everything does not come. Many patients do not even know what is the reason for such unsuccessful attempts, and precious time for effective treatment leaves. Therefore, if pregnancy does not occur within a year, then it is necessary to undergo full examination from specialists.

What are spikes?

The pelvic organs of a woman (uterus, fallopian tubes, ovaries, bladder, rectum) are covered on the outside with a thin shiny membrane - the peritoneum. The smoothness of the peritoneum, combined with a small amount of fluid in the abdominal cavity, provides good displacement of the pelvic organs during physiological processes. So, if the bladder is filled, the uterus with the rectum deviate backwards, if the intestines are full, then the bladder and uterus are displaced anteriorly. During pregnancy, the already growing uterus causes both the bladder and intestines to shrink.

With the development of an inflammatory process in the small pelvis, the peritoneum in the focus of inflammation swells and becomes covered with a sticky coating containing fibrin(a protein that forms the basis of a blood clot). A film of fibrin on the surface of the peritoneum in the focus of inflammation glues adjacent surfaces to each other in order to prevent the spread of the inflammatory process to other organs. After recovery, the fibrin film is easily absorbed. If inflammatory process is delayed, then fibrin is impregnated with other substances (collagen, fibronectin), which leads to the formation of persistent connective tissue bridges between organs. These adhesions are called spikes. The formation of adhesions is, in a way, defense mechanism body for chronic damage or inflammation of the peritoneum, the purpose of which is to prevent the spread of the disease throughout the abdominal cavity.

However, despite the positive protective effect, spikes can interfere normal operation internal organs. Impaired intestinal motility can lead to intestinal obstruction. Adhesions affecting the female genital organs can be the cause of infertility and pelvic pain. The most vulnerable in this regard is oviduct- one of the most delicate and finely arranged smooth muscle organs. Normally, the wave-like movements of the fallopian tube help the sperm to move towards the egg, and the processes on its internal (abdominal) opening, the so-called fimbria, capture the egg after ovulation, delivering it to the sperm. Directly in the fallopian tube, the spermatozoon merges with the egg (fertilization). After fertilization, the movement of the fallopian tube and the work of its microcilia inner surface promote the embryo into the uterine cavity. The fallopian tube not only ensures the transport of germ cells and the embryo, but also creates an environment for fertilization and development of the embryo during the first 5-6 days prenatal development. The formation of adhesions inside or outside the tube can clog its lumen, disrupt the correct movement of the tube (peristalsis), which leads to infertility or the onset of an ectopic pregnancy.

Causes of adhesive disease

The main causes of peritoneal irritation and development adhesive disease small pelvis is considered to be:

Various surgical interventions in the pelvic cavity.
The mechanism of regeneration is the same, regardless of the place of formation. When there is any tissue damage, the body tries to restore the structure of this damaged tissue. Normally, this process takes place due to intensive cell division. But it's long. If the body needs to quickly fill the defect, then the structures are filled connective tissue. Big wound surface – main reason formation of adhesions after surgery. Thus, the number of adhesions after an open caesarean section is twice as high as after laparoscopic operations. In addition to this, the formation postoperative adhesions contributes to insufficient supply of tissues with blood and oxygen during ligation of blood vessels, thorough drying of tissues during surgery, prolonged presence of blood (blood is a source of fibrin) and foreign bodies. TO foreign bodies, causing education adhesions, may include particles of talc from doctor's gloves, small fibers with gauze swabs, suture material. In the uterine cavity, abortions can lead to the formation of adhesions, as well as any mechanical impact damaging the walls of the uterus.

Inflammatory diseases of the pelvic organs, especially chronic diseases appendages.
Cause chronic inflammation most often become sexually transmitted infections (chlamydia, gonorrhea, mycoplasmosis). Also, the uterine appendages (fallopian tubes and ovaries) can be involved in inflammation of neighboring organs, for example, with appendicitis - inflammation appendix. local immunity inside the fallopian tube is minimal, since the activity immune system unfavorable for the development of pregnancy (it can destroy the embryo, as a foreign object). This is why the fallopian tubes so easily fall victim to the so-called ascending infection (coming from the vagina and uterine cavity).
Once in the fallopian tubes, the infection first affects the mucous membrane of the fallopian tube, forming adhesions inside the tube, and only then - muscle layer and the peritoneum covering the tubes from the outside. The inflamed peritoneum leads to the formation adhesions between pipes and other pelvic organs. Any delay in treating the infection leads to irreversible changes inside the tube: the microcilia of the mucosal tube disappear, and the muscularis is replaced by connective tissue. Naturally, such a tube can no longer perform the function of fertilization. And even if it is possible to separate the adhesions of the pipe and other organs during the operation, the function of the pipe is not restored. In severe cases, the fallopian tube turns into a connective tissue sac (sactosalpinx), which is the focus of inflammation. This focus leads to a decrease in the likelihood of pregnancy even in the tube from the opposite side or with the help of IVF. To increase the chances of pregnancy with IVF, which can be carried out after recovery, with sactosalpix, the tube is removed entirely.